Predictive Factors and Microbial Spectrum for Infectious Complications after Hepatectomy with Cholangiojejunostomy in Perihilar Cholangiocarcinoma
Background: Despite advances in surgical techniques and peri-operative management, post-operative infectious complications still are common after perihilar cholangiocarcinoma (PHCC). This study investigated the predictive factors and microbial spectrum for infections after hepatectomy with cholangio...
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| Veröffentlicht in: | Surgical infections 2020-04, Vol.21 (3), p.275-283 |
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| creator | Chen, Xiaoyuan Sun, Shiquan Yan, Xiaopeng Fu, Xu Fan, Yinyin Chen, Dayu Qiu, Yudong Mao, Liang |
| description | Background:
Despite advances in surgical techniques and peri-operative management, post-operative infectious complications still are common after perihilar cholangiocarcinoma (PHCC). This study investigated the predictive factors and microbial spectrum for infections after hepatectomy with cholangiojejunostomy performed to treat PHCC.
Methods:
A total of 70 consecutive patients, who underwent hepatectomy with cholangiojejunostomy by the same surgeons at a tertiary referral medical center between September 2010 and January 2019, were enrolled. Clinical data were reviewed for multivariable analysis to find independent risk factors for infectious complications. Microorganisms isolated from bile and infection sites were counted to explore the microbial spectrum.
Results:
A total of 43 patients (61.4%) suffered post-operative infections (33 with surgical site infection [SSI], four with bacteremia, three with pneumonia, 10 with cholangitis, and two with fungus infectious stomatitis), and 28 of them (65.1%) had a positive bile culture. Four independent risk factors were identified: male sex (odds ratio [OR] 12.737; 95% confidence interval [CI] 2.298–70.611; p = 0.004), red blood cell (RBC) count |
| doi_str_mv | 10.1089/sur.2019.199 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2313660269</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2313660269</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-848f192b126ae4cc791305fd0b22e36253174e3c6d28eff20c0575acd5444f3b3</originalsourceid><addsrcrecordid>eNp9kUtv3CAUhVHUKK9m13XFsot6wsPGZlmN8pKmykhJ1xbGlwwjG1zAifI3-ovLZJJ2lxX3wsfRvecg9IWSBSWNvIhzWDBC5YJKeYBOaFXVRSPq8lOuiRQFk6I8RqcxbgmhNRPiCB1zWlOSyxP0Zx2gtzrZJ8BXSicfIlauxz-tDr6zasD3E-gU5hEbH_CtM7mzfo546cdpsFrlzuU_JkHANzCplAE_vuBnmzZ4ufGDco_Wb2E7Ox9fX6zDawh2YwcV_hNaBW2dH9VndGjUEOH87TxDv64uH5Y3xeru-nb5Y1VoXrNUNGVjqGQdZUJBqXUtKSeV6UnHGHDBqrxkCVyLnjVgDCOaVHWldF-VZWl4x8_Qt73uFPzvGWJqRxs1DHkcyAu2jFMuRLZJZvT7Hs2mxBjAtFOwowovLSXtLoU2p9DuUmhzChn_-qY8dyP0_-B32zPA9sDuWjk3WOggpI9V_wLi9pfx</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2313660269</pqid></control><display><type>article</type><title>Predictive Factors and Microbial Spectrum for Infectious Complications after Hepatectomy with Cholangiojejunostomy in Perihilar Cholangiocarcinoma</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Chen, Xiaoyuan ; Sun, Shiquan ; Yan, Xiaopeng ; Fu, Xu ; Fan, Yinyin ; Chen, Dayu ; Qiu, Yudong ; Mao, Liang</creator><creatorcontrib>Chen, Xiaoyuan ; Sun, Shiquan ; Yan, Xiaopeng ; Fu, Xu ; Fan, Yinyin ; Chen, Dayu ; Qiu, Yudong ; Mao, Liang</creatorcontrib><description>Background:
Despite advances in surgical techniques and peri-operative management, post-operative infectious complications still are common after perihilar cholangiocarcinoma (PHCC). This study investigated the predictive factors and microbial spectrum for infections after hepatectomy with cholangiojejunostomy performed to treat PHCC.
Methods:
A total of 70 consecutive patients, who underwent hepatectomy with cholangiojejunostomy by the same surgeons at a tertiary referral medical center between September 2010 and January 2019, were enrolled. Clinical data were reviewed for multivariable analysis to find independent risk factors for infectious complications. Microorganisms isolated from bile and infection sites were counted to explore the microbial spectrum.
Results:
A total of 43 patients (61.4%) suffered post-operative infections (33 with surgical site infection [SSI], four with bacteremia, three with pneumonia, 10 with cholangitis, and two with fungus infectious stomatitis), and 28 of them (65.1%) had a positive bile culture. Four independent risk factors were identified: male sex (odds ratio [OR] 12.737; 95% confidence interval [CI] 2.298–70.611; p = 0.004), red blood cell (RBC) count <3.8 × 10
12
/L (OR 5.085; 95% CI 1.279–20.211; p = 0.021), total cholesterol (TC) <2.90 mmol/L (OR 5.715; 95% CI 1.534–21.299; p = 0.009), and serum Na
+
>145 mmol/L (OR 10.387; 95% CI 1.559–69.201; p = 0.016) on post-operative day (POD) 1. A total of 217 and 196 microorganisms were cultured from 311 and 627 specimens, respectively, collected from pre-/intra-operative bile and possible infection sites.
Staphylococcus
,
Enterococcus
,
Acinetobacter, Streptococcus,
and
Escherichia
were the most common findings of bile culture. The first five organisms most frequently isolated from infection sites were
Enterococcus, Staphylococcus, Klebsiella, Acinetobacter,
and
Candida
. A total of 18 patients (64.3%) had at least one species isolated from infection sites that had appeared in a previous bile culture.
Conclusions:
Male sex, erythrocytopenia, hypocholesterolemia, and hypernatremia on POD 1 are independent risk factors for infectious complications. For patients without positive bile cultures, third-generation cephalosporins could be considered as the prophylactic antibiotic. It is important to monitor the pathogens throughout the hospital stay.</description><identifier>ISSN: 1096-2964</identifier><identifier>EISSN: 1557-8674</identifier><identifier>DOI: 10.1089/sur.2019.199</identifier><identifier>PMID: 31710266</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc., publishers</publisher><subject>Acinetobacter ; Acinetobacter Infections - epidemiology ; Aged ; Anastomosis, Surgical ; Anemia - epidemiology ; Bacteremia - epidemiology ; Bacteremia - microbiology ; Bile Duct Neoplasms - surgery ; Candidiasis, Oral - epidemiology ; Candidiasis, Oral - microbiology ; Cholangitis - epidemiology ; Cholangitis - microbiology ; Dyslipidemias - epidemiology ; Enterococcus ; Erythrocyte Count ; Escherichia coli ; Escherichia coli Infections - epidemiology ; Female ; Gram-Positive Bacterial Infections - epidemiology ; Hepatectomy ; Humans ; Hypernatremia - epidemiology ; Jejunum - surgery ; Klatskin Tumor - surgery ; Klebsiella ; Klebsiella Infections - epidemiology ; Male ; Middle Aged ; Original Articles ; Pneumonia - epidemiology ; Pneumonia - microbiology ; Postoperative Complications - epidemiology ; Postoperative Complications - microbiology ; Risk Factors ; Sex Factors ; Staphylococcal Infections - epidemiology ; Staphylococcus ; Streptococcal Infections - epidemiology ; Streptococcus ; Surgical Wound Infection - epidemiology ; Surgical Wound Infection - microbiology</subject><ispartof>Surgical infections, 2020-04, Vol.21 (3), p.275-283</ispartof><rights>2020, Mary Ann Liebert, Inc., publishers</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-848f192b126ae4cc791305fd0b22e36253174e3c6d28eff20c0575acd5444f3b3</citedby><cites>FETCH-LOGICAL-c372t-848f192b126ae4cc791305fd0b22e36253174e3c6d28eff20c0575acd5444f3b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31710266$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Xiaoyuan</creatorcontrib><creatorcontrib>Sun, Shiquan</creatorcontrib><creatorcontrib>Yan, Xiaopeng</creatorcontrib><creatorcontrib>Fu, Xu</creatorcontrib><creatorcontrib>Fan, Yinyin</creatorcontrib><creatorcontrib>Chen, Dayu</creatorcontrib><creatorcontrib>Qiu, Yudong</creatorcontrib><creatorcontrib>Mao, Liang</creatorcontrib><title>Predictive Factors and Microbial Spectrum for Infectious Complications after Hepatectomy with Cholangiojejunostomy in Perihilar Cholangiocarcinoma</title><title>Surgical infections</title><addtitle>Surg Infect (Larchmt)</addtitle><description>Background:
Despite advances in surgical techniques and peri-operative management, post-operative infectious complications still are common after perihilar cholangiocarcinoma (PHCC). This study investigated the predictive factors and microbial spectrum for infections after hepatectomy with cholangiojejunostomy performed to treat PHCC.
Methods:
A total of 70 consecutive patients, who underwent hepatectomy with cholangiojejunostomy by the same surgeons at a tertiary referral medical center between September 2010 and January 2019, were enrolled. Clinical data were reviewed for multivariable analysis to find independent risk factors for infectious complications. Microorganisms isolated from bile and infection sites were counted to explore the microbial spectrum.
Results:
A total of 43 patients (61.4%) suffered post-operative infections (33 with surgical site infection [SSI], four with bacteremia, three with pneumonia, 10 with cholangitis, and two with fungus infectious stomatitis), and 28 of them (65.1%) had a positive bile culture. Four independent risk factors were identified: male sex (odds ratio [OR] 12.737; 95% confidence interval [CI] 2.298–70.611; p = 0.004), red blood cell (RBC) count <3.8 × 10
12
/L (OR 5.085; 95% CI 1.279–20.211; p = 0.021), total cholesterol (TC) <2.90 mmol/L (OR 5.715; 95% CI 1.534–21.299; p = 0.009), and serum Na
+
>145 mmol/L (OR 10.387; 95% CI 1.559–69.201; p = 0.016) on post-operative day (POD) 1. A total of 217 and 196 microorganisms were cultured from 311 and 627 specimens, respectively, collected from pre-/intra-operative bile and possible infection sites.
Staphylococcus
,
Enterococcus
,
Acinetobacter, Streptococcus,
and
Escherichia
were the most common findings of bile culture. The first five organisms most frequently isolated from infection sites were
Enterococcus, Staphylococcus, Klebsiella, Acinetobacter,
and
Candida
. A total of 18 patients (64.3%) had at least one species isolated from infection sites that had appeared in a previous bile culture.
Conclusions:
Male sex, erythrocytopenia, hypocholesterolemia, and hypernatremia on POD 1 are independent risk factors for infectious complications. For patients without positive bile cultures, third-generation cephalosporins could be considered as the prophylactic antibiotic. It is important to monitor the pathogens throughout the hospital stay.</description><subject>Acinetobacter</subject><subject>Acinetobacter Infections - epidemiology</subject><subject>Aged</subject><subject>Anastomosis, Surgical</subject><subject>Anemia - epidemiology</subject><subject>Bacteremia - epidemiology</subject><subject>Bacteremia - microbiology</subject><subject>Bile Duct Neoplasms - surgery</subject><subject>Candidiasis, Oral - epidemiology</subject><subject>Candidiasis, Oral - microbiology</subject><subject>Cholangitis - epidemiology</subject><subject>Cholangitis - microbiology</subject><subject>Dyslipidemias - epidemiology</subject><subject>Enterococcus</subject><subject>Erythrocyte Count</subject><subject>Escherichia coli</subject><subject>Escherichia coli Infections - epidemiology</subject><subject>Female</subject><subject>Gram-Positive Bacterial Infections - epidemiology</subject><subject>Hepatectomy</subject><subject>Humans</subject><subject>Hypernatremia - epidemiology</subject><subject>Jejunum - surgery</subject><subject>Klatskin Tumor - surgery</subject><subject>Klebsiella</subject><subject>Klebsiella Infections - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original Articles</subject><subject>Pneumonia - epidemiology</subject><subject>Pneumonia - microbiology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - microbiology</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Staphylococcal Infections - epidemiology</subject><subject>Staphylococcus</subject><subject>Streptococcal Infections - epidemiology</subject><subject>Streptococcus</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>Surgical Wound Infection - microbiology</subject><issn>1096-2964</issn><issn>1557-8674</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtv3CAUhVHUKK9m13XFsot6wsPGZlmN8pKmykhJ1xbGlwwjG1zAifI3-ovLZJJ2lxX3wsfRvecg9IWSBSWNvIhzWDBC5YJKeYBOaFXVRSPq8lOuiRQFk6I8RqcxbgmhNRPiCB1zWlOSyxP0Zx2gtzrZJ8BXSicfIlauxz-tDr6zasD3E-gU5hEbH_CtM7mzfo546cdpsFrlzuU_JkHANzCplAE_vuBnmzZ4ufGDco_Wb2E7Ox9fX6zDawh2YwcV_hNaBW2dH9VndGjUEOH87TxDv64uH5Y3xeru-nb5Y1VoXrNUNGVjqGQdZUJBqXUtKSeV6UnHGHDBqrxkCVyLnjVgDCOaVHWldF-VZWl4x8_Qt73uFPzvGWJqRxs1DHkcyAu2jFMuRLZJZvT7Hs2mxBjAtFOwowovLSXtLoU2p9DuUmhzChn_-qY8dyP0_-B32zPA9sDuWjk3WOggpI9V_wLi9pfx</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Chen, Xiaoyuan</creator><creator>Sun, Shiquan</creator><creator>Yan, Xiaopeng</creator><creator>Fu, Xu</creator><creator>Fan, Yinyin</creator><creator>Chen, Dayu</creator><creator>Qiu, Yudong</creator><creator>Mao, Liang</creator><general>Mary Ann Liebert, Inc., publishers</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200401</creationdate><title>Predictive Factors and Microbial Spectrum for Infectious Complications after Hepatectomy with Cholangiojejunostomy in Perihilar Cholangiocarcinoma</title><author>Chen, Xiaoyuan ; Sun, Shiquan ; Yan, Xiaopeng ; Fu, Xu ; Fan, Yinyin ; Chen, Dayu ; Qiu, Yudong ; Mao, Liang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-848f192b126ae4cc791305fd0b22e36253174e3c6d28eff20c0575acd5444f3b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acinetobacter</topic><topic>Acinetobacter Infections - epidemiology</topic><topic>Aged</topic><topic>Anastomosis, Surgical</topic><topic>Anemia - epidemiology</topic><topic>Bacteremia - epidemiology</topic><topic>Bacteremia - microbiology</topic><topic>Bile Duct Neoplasms - surgery</topic><topic>Candidiasis, Oral - epidemiology</topic><topic>Candidiasis, Oral - microbiology</topic><topic>Cholangitis - epidemiology</topic><topic>Cholangitis - microbiology</topic><topic>Dyslipidemias - epidemiology</topic><topic>Enterococcus</topic><topic>Erythrocyte Count</topic><topic>Escherichia coli</topic><topic>Escherichia coli Infections - epidemiology</topic><topic>Female</topic><topic>Gram-Positive Bacterial Infections - epidemiology</topic><topic>Hepatectomy</topic><topic>Humans</topic><topic>Hypernatremia - epidemiology</topic><topic>Jejunum - surgery</topic><topic>Klatskin Tumor - surgery</topic><topic>Klebsiella</topic><topic>Klebsiella Infections - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original Articles</topic><topic>Pneumonia - epidemiology</topic><topic>Pneumonia - microbiology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - microbiology</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Staphylococcal Infections - epidemiology</topic><topic>Staphylococcus</topic><topic>Streptococcal Infections - epidemiology</topic><topic>Streptococcus</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>Surgical Wound Infection - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Xiaoyuan</creatorcontrib><creatorcontrib>Sun, Shiquan</creatorcontrib><creatorcontrib>Yan, Xiaopeng</creatorcontrib><creatorcontrib>Fu, Xu</creatorcontrib><creatorcontrib>Fan, Yinyin</creatorcontrib><creatorcontrib>Chen, Dayu</creatorcontrib><creatorcontrib>Qiu, Yudong</creatorcontrib><creatorcontrib>Mao, Liang</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical infections</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Xiaoyuan</au><au>Sun, Shiquan</au><au>Yan, Xiaopeng</au><au>Fu, Xu</au><au>Fan, Yinyin</au><au>Chen, Dayu</au><au>Qiu, Yudong</au><au>Mao, Liang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictive Factors and Microbial Spectrum for Infectious Complications after Hepatectomy with Cholangiojejunostomy in Perihilar Cholangiocarcinoma</atitle><jtitle>Surgical infections</jtitle><addtitle>Surg Infect (Larchmt)</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>21</volume><issue>3</issue><spage>275</spage><epage>283</epage><pages>275-283</pages><issn>1096-2964</issn><eissn>1557-8674</eissn><abstract>Background:
Despite advances in surgical techniques and peri-operative management, post-operative infectious complications still are common after perihilar cholangiocarcinoma (PHCC). This study investigated the predictive factors and microbial spectrum for infections after hepatectomy with cholangiojejunostomy performed to treat PHCC.
Methods:
A total of 70 consecutive patients, who underwent hepatectomy with cholangiojejunostomy by the same surgeons at a tertiary referral medical center between September 2010 and January 2019, were enrolled. Clinical data were reviewed for multivariable analysis to find independent risk factors for infectious complications. Microorganisms isolated from bile and infection sites were counted to explore the microbial spectrum.
Results:
A total of 43 patients (61.4%) suffered post-operative infections (33 with surgical site infection [SSI], four with bacteremia, three with pneumonia, 10 with cholangitis, and two with fungus infectious stomatitis), and 28 of them (65.1%) had a positive bile culture. Four independent risk factors were identified: male sex (odds ratio [OR] 12.737; 95% confidence interval [CI] 2.298–70.611; p = 0.004), red blood cell (RBC) count <3.8 × 10
12
/L (OR 5.085; 95% CI 1.279–20.211; p = 0.021), total cholesterol (TC) <2.90 mmol/L (OR 5.715; 95% CI 1.534–21.299; p = 0.009), and serum Na
+
>145 mmol/L (OR 10.387; 95% CI 1.559–69.201; p = 0.016) on post-operative day (POD) 1. A total of 217 and 196 microorganisms were cultured from 311 and 627 specimens, respectively, collected from pre-/intra-operative bile and possible infection sites.
Staphylococcus
,
Enterococcus
,
Acinetobacter, Streptococcus,
and
Escherichia
were the most common findings of bile culture. The first five organisms most frequently isolated from infection sites were
Enterococcus, Staphylococcus, Klebsiella, Acinetobacter,
and
Candida
. A total of 18 patients (64.3%) had at least one species isolated from infection sites that had appeared in a previous bile culture.
Conclusions:
Male sex, erythrocytopenia, hypocholesterolemia, and hypernatremia on POD 1 are independent risk factors for infectious complications. For patients without positive bile cultures, third-generation cephalosporins could be considered as the prophylactic antibiotic. It is important to monitor the pathogens throughout the hospital stay.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc., publishers</pub><pmid>31710266</pmid><doi>10.1089/sur.2019.199</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Surgical infections, 2020-04, Vol.21 (3), p.275-283 |
| issn | 1096-2964 1557-8674 |
| language | eng |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Acinetobacter Acinetobacter Infections - epidemiology Aged Anastomosis, Surgical Anemia - epidemiology Bacteremia - epidemiology Bacteremia - microbiology Bile Duct Neoplasms - surgery Candidiasis, Oral - epidemiology Candidiasis, Oral - microbiology Cholangitis - epidemiology Cholangitis - microbiology Dyslipidemias - epidemiology Enterococcus Erythrocyte Count Escherichia coli Escherichia coli Infections - epidemiology Female Gram-Positive Bacterial Infections - epidemiology Hepatectomy Humans Hypernatremia - epidemiology Jejunum - surgery Klatskin Tumor - surgery Klebsiella Klebsiella Infections - epidemiology Male Middle Aged Original Articles Pneumonia - epidemiology Pneumonia - microbiology Postoperative Complications - epidemiology Postoperative Complications - microbiology Risk Factors Sex Factors Staphylococcal Infections - epidemiology Staphylococcus Streptococcal Infections - epidemiology Streptococcus Surgical Wound Infection - epidemiology Surgical Wound Infection - microbiology |
| title | Predictive Factors and Microbial Spectrum for Infectious Complications after Hepatectomy with Cholangiojejunostomy in Perihilar Cholangiocarcinoma |
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